尿素氮与血清肌酐比值在肾小球滤过功能保留急性冠状动脉综合征患者中应用价值

The ratio of urea nitrogen to serum creatinine is a risk factor for acute coronary syndromes in patients with preserved glomerular filtration function

目的探讨尿素氮与血清肌酐比值(BUN/Cr)在肾小球滤过率(eGFR)≥90 ml/min的急性冠状动脉综合征(ACS)患者中的应用价值。方法选取自2012年1月至2014年3月冠心病抗血小板治疗优选方案(OPT⁃CAD)研究数据库中6193例eGFR估计值≥90 ml/min的ACS患者为研究对象。主要终点为患者出院后5年内发生的由心原性死亡、心肌梗死及卒中构成的主要不良心血管事件(MACE)复合终点。次要终点为5年内发生MACE中的各独立组成成分。通过多元回归分析,确定BUN/Cr是否为MACE的相关因素,并构建受试者工作特征曲线(ROC)得出预测MACE事件的最佳阈值。随后采用生存分析方法比较BUN/Cr高于和低于预测值的患者发生不良事件的风险比。结果BUN/Cr升高是eGFR≥90 ml/min合并ACS人群5年内发生MACE事件的危险因素。BUN/Cr对5年内发生MACE事件的最佳预测界值是20.86。根据ROC所得cut⁃off值将患者分为BUN/Cr较高组(BUN/Cr≥20.86)及BUN/Cr较低组(BUN/Cr<20.86)。BUN/Cr较高组的MACE发生率高于BUN/Cr较低组,差异有统计学意义(P<0.001)。BUN/Cr较高组5年内心原性死亡事件、心肌梗死及卒中发生率也高于BUN/Cr较低组,差异有统计学意义(P<0.05)。BUN/Cr≥20.86的患者发生MACE事件的风险是BUN/Cr<20.86患者的1.48倍。结论BUN/Cr可能是一个独立于eGFR下降的可用于评价ACS患者预后不良的肾功能相关性指标。BUN/Cr的升高可能与ACS患者出院后5年内发生包括心原性死亡、心肌梗死及卒中在内的MACE风险增加有关。

Objective To investigate the application value of blood urea nitrogen to serum creatinine ratio(BUN/Cr)in patients with acute coronary syndrome(ACS)with glomerular filtration rate(eGFR)≥90 ml/min.Methods A total of 6193 ACS patients with an estimated eGFR≥90 ml/min were selected from the coronary artery disease antiplatelet therapy preferred protocol(OPT⁃CAD)data⁃base from January 2012 to March 2014.The primary end point was the composite of major adverse cardiovascular events(MACE)con⁃sisting of cardiac death,myocardial infarction,and stroke within 5 years after discharge.Secondary endpoints were independent compo⁃nents of MACE occurring within 5 years.Multiple regression analysis was used to determine whether BUN/Cr was a factor related to MACE,and receiver operating characteristic curve(ROC)was constructed to obtain the optimal threshold for predicting MACE e⁃vents.Survival analysis was then used to compare the risk ratios of adverse events in patients with higher and lower BUN/Cr than pre⁃dicted.Results Elevated BUN/Cr was a risk factor for MACE events in patients with eGFR≥90 ml/min combined with ACS within 5 years.The best prediction threshold of BUN/Cr for MACE events within 5 years was 20.86.Patients were divided into higher BUN/Cr group(BUN/Cr≥20.86)and lower BUN/Cr group(BUN/Cr<20.86)according to the cut⁃off value obtained by ROC.The incidence of MACE in the higher BUN/Cr group was higher than that in the lower BUN/Cr group,and the difference was statistically significant(P<0.001).The incidence of 5⁃year visceral death,myocardial infarction and stroke in the higher BUN/Cr group was also higher than that in the lower BUN/Cr group,and the difference was statistically significant(P<0.05).The risk of MACE events was 1.48 times higher in patients with BUN/Cr≥20.86 than in patients with BUN/Cr<20.86.Conclusion BUN/Cr may be an indica tor of renal function independent of eGFR decline that can be used to evaluate poor prognosis in patients with ACS.Increased BUN/Cr may be associated with an increased risk of MACE,including cardiac death,myocardial infarction and stroke,in patients with ACS within 5 years after discharge.